Healthcare Provider Details

I. General information

NPI: 1942812649
Provider Name (Legal Business Name): HOMEWARD BOUND MEDICAL SUPPLIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3836 SE DIXIE HWY
STUART FL
34997-6055
US

IV. Provider business mailing address

416 W SKELLY ST
CUBA CITY WI
53807-1035
US

V. Phone/Fax

Practice location:
  • Phone: 772-210-6711
  • Fax: 772-210-6159
Mailing address:
  • Phone: 608-790-4381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: VANESSA MARIE HUDSON
Title or Position: MANAGER / OWNER
Credential:
Phone: 608-790-4381